You Keep Treating Yeast Infections—But They Keep Coming Back

You’ve felt the itch, the burn, the irritation—and headed straight to the pharmacy (again). But if those “yeast infections” keep returning, even after treatment, something deeper might be going on.
Many people assigned female at birth are misdiagnosed with chronic yeast infections when the actual cause is either Hormonally Mediated Vestibulodynia (HMV) or Pelvic Floor Dysfunction (PFD)—two underdiagnosed conditions that mimic infection symptoms, but don’t respond to antifungals.
Let’s break it all down.

What Are Recurrent Vaginal Infections?

Recurrent vaginal infections typically mean 4 or more yeast infections in a year, and they’re usually treated with antifungal medications like fluconazole or over-the-counter creams.
But here’s the catch:
If your symptoms never fully go away, or if tests keep coming back negative, it may not be a yeast infection at all.

What Is Hormonally Mediated Vestibulodynia (HMV)?

HMV is a chronic pain condition where hormonal imbalances (especially low estrogen or testosterone) cause inflammation and hypersensitivity in the vestibule—the area right around your vaginal opening.

HMV Symptoms That Mimic Yeast Infections:

• Burning or stinging around the vaginal opening

• Itching or irritation that won’t go away

• Pain with penetration (sex, tampons, exams)

• No relief from antifungals

Key difference? HMV isn’t caused by yeast—it’s hormonally driven. That’s why creams and meds don’t work.

Could It Be Pelvic Floor Dysfunction Instead?

Pelvic Floor Dysfunction (PFD) happens when the muscles in your pelvic floor are either too tight or uncoordinated—creating tension, pain, and pressure that radiate through the vaginal area.

PFD Can Feel Like:

• Chronic irritation or rawness

• Burning or stinging during or after sex

• Pressure or discomfort while sitting

• Urinary urgency or constipation

Again, not an infection. No fungus. No bacteria. Just muscles misfiring—and needing proper care.

Why Are These Conditions So Often Misdiagnosed?

1. Symptom Overlap
Burning, itching, and irritation are classic for all three—yeast, HMV, and PFD. Without a thorough exam, it’s easy to treat the wrong one.

2. Lack of Provider Training
Most providers are taught to spot infections—but not vestibulodynia or pelvic floor issues. So they reach for what they know: antifungals.

3. The Fast Fix Culture
You’re in pain. They want to help—fast. A pill is easier than a 30-minute exam. But easy isn’t always accurate.

How to Get the Right Diagnosis

If you’ve been misdiagnosed, you’re not alone. But there is a path forward.

1. Keep a Symptom Log
Note what triggers the pain (sex, stress, tight clothes?), what helps (ice, rest, lube?), and what doesn’t.

2. Ask for Hormone Testing
Low estrogen or testosterone might be to blame. Ask for a full hormone panel, especially if you’re postpartum, breastfeeding, on birth control, or nearing menopause.

3. Get a Pelvic Floor Assessment
A pelvic floor therapist can assess whether tight or overactive muscles are behind your pain—and teach you how to release them.

4. See a Vulvovaginal Specialist
Find someone who gets it. Vulvar pain specialists are trained to recognize HMV and PFD—and treat the root cause, not just the symptoms.

Treatment Options for HMV and PFD

The right treatment depends on what’s driving your symptoms—but here’s what typically helps:

For Hormonally Mediated Vestibulodynia:

• Topical estrogen or testosterone creams for the vestibule

• Systemic hormone therapy if needed

• Avoiding scented soaps, wipes, and douches

• Pelvic floor physical therapy if muscles are involved

For Pelvic Floor Dysfunction:

• Pelvic floor therapy (think: internal massage, biofeedback, breathing exercises)

• Trigger point release + movement retraining

• Stress management and body awareness

• Posture and ergonomic adjustments

TL;DR: It’s not in your head. It’s in your hormones and your muscles—and both are treatable.

The Emotional Weight of Misdiagnosis

If you’ve been through the cycle of repeat infections, you know the toll it takes:
Missed work. Skipped dates. Awkward conversations. Exhaustion. Gaslighting.

But it’s not your fault. And it’s not "just stress." Your pain deserves real attention.

Final Thoughts: You’re Not Broken. You Just Need the Right Diagnosis.

If yeast infections are your default assumption—but treatment never fully works—it’s time to look deeper.
HMV and PFD are both real, underdiagnosed, and absolutely treatable.
You just need the right support team.